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Endoscopic Extracapsular Capsulectomy of the Elbow: A Neurovascularly Safe Technique for High-Grade Contractures

  • Srinath Kamineni
    Correspondence
    Address correspondence and reprint requests to Srinath Kamineni, F.R.C.S., Department of Orthopaedics and Trauma, Cromwell Hospital, Cromwell Rd, London SW5 0TU, England.
    Affiliations
    Department of Elbow, Shoulder, and Upper Limb Surgery, Brunel University, Uxbridge, England

    Department of Bioengineering, Brunel University, Uxbridge, England

    Department of Orthopaedics and Trauma, Cromwell Hospital, London, England
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  • Felix H. Savoie III
    Affiliations
    Upper Extremity Service, Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A.

    Department of Orthopaedic Surgery, University of Mississippi Medical School, Jackson, Mississippi, U.S.A.
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  • Neil ElAttrache
    Affiliations
    Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California, U.S.A.
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      Abstract

      Arthroscopic management of elbow contractures is rapidly becoming the primary operative form of treatment for many physicians. Safety concerns remain the primary limiting factor in its more widespread use. We use an extra-articular starting point in extremely difficult fixed contractures, and this technique is documented in this report. The ulnar nerve is initially identified and protected with a palpating finger, while a periosteal elevator is introduced through a proximal medial skin portal. A channel between the anterior humeral cortex and anterior musculature is created, and an arthroscope is introduced through a proximal lateral portal at the lateral aspect of the channel. The anterior capsule is dissected from the musculature/neurovasculature under direct vision and safely excised once the medial and lateral margins are safely identified. A useful technical tip is that retractors can be placed in auxiliary portals to deflect the muscles and fat pad to improve the ability to perform dissection under direct vision.

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      References

        • Mansat P.
        • Morrey B.F.
        The column procedure: A limited lateral approach for extrinsic contracture of the elbow.
        J Bone Joint Surg Am. 1998; 80: 1603-1615
        • Nowicki K.D.
        • Shall L.M.
        Arthroscopic release of a posttraumatic flexion contracture in the elbow: A case report and review of the literature.
        Arthroscopy. 1992; 8: 544-547
        • Gallay S.H.
        • Richards R.R.
        • O’Driscoll S.W.
        Intraarticular capacity and compliance of stiff and normal elbows.
        Arthroscopy. 1993; 9: 9-13
        • Papilion J.D.
        • Neff R.S.
        • Shall L.M.
        Compression neuropathy of the radial nerve as a complication of elbow arthroscopy: A case report and review of the literature.
        Arthroscopy. 1988; 4: 284-286
        • Ruch D.S.
        • Poehling G.G.
        Anterior interosseous nerve injury following elbow arthroscopy.
        Arthroscopy. 1997; 13: 756-758
        • Poehling G.G.
        • Whipple T.L.
        • Sisco L.
        • Goldman B.
        Elbow arthroscopy: A new technique.
        Arthroscopy. 1989; 5: 222-224
        • Lynch G.J.
        • Myers J.F.
        • Whipple T.L.
        • et al.
        Neurovascular anatomy and elbow arthroscopy: Inherent risks.
        Arthroscopy. 1986; 2: 190-197
        • Cassells S.W.
        Neurovascular anatomy and elbow arthroscopy: Inherent risks, editor’s comment.
        Arthroscopy. 1986; 2: 190
        • Marshall P.D.
        • Fairclough J.A.
        • Johnson S.R.
        • et al.
        Avoiding nerve damage during elbow arthroscopy.
        J Bone Joint Surg Br. 1993; 75: 129-131
        • Verhaar J.
        • van Mameren H.
        • Brandsma H.
        Risks of neurovascular injury in elbow arthroscopy: Starting anteromedially or anterolaterally?.
        Arthroscopy. 1991; 7: 287-290
        • Thomas M.A.
        • Fast A.
        • Shapiro D.
        Radial nerve damage as a complication of elbow arthroscopy.
        Clin Orthop. 1987; 215: 130-131
        • Jones G.S.
        • Savoie F.H.
        Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow.
        Arthroscopy. 1993; 9: 277-283
        • Haapaniemi T.
        • Berggren M.
        • Adolfsson L.
        Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture.
        Arthroscopy. 1999; 15: 784-787
        • Miller C.D.
        • Jobe C.M.
        • Wright M.H.
        Neuroanatomy in elbow arthroscopy.
        J Shoulder Elbow Surg. 1995; 4: 168-174
        • Gates III, H.S.
        • Sullivan F.L.
        • Urbaniak J.R.
        Anterior capsulotomy and continuous passive motion in the treatment of post-traumatic flexion contracture of the elbow.
        J Bone Joint Surg Am. 1992; 74: 1229-1234
        • Urbaniak J.R.
        • Hansen P.E.
        • Beissinger S.F.
        • Aitken M.S.
        Correction of post-traumatic flexion contracture of the elbow by anterior capsulotomy.
        J Bone Joint Surg Am. 1985; 67: 1160-1164